Wholeheartedly: Let's Talk About Sex: Part 2 (seems to be all I talk about anymore)

It has been quite a busy week for me. It has also been full of ups and downs. I started the week off with HIV education at Malonda Primary School. Primary school is what we would call elementary school. They have standards 1-8, so children are generally 6-14 in these grades; although there is a much greater mix of ages than in an American classroom. Many children struggle through school, I believe this has a lot to do with attendance rates, high classroom sizes (usually about 100 or more children per one teacher), uneducated parents, and education is not a high priority. So teaching HIV to such a wide age range per class is kind of a challenge. I of course did not go in with a specific plan, I am not a planner, I am also not a teacher, I am a nurse and I just like to use conversation as teaching tools. But I did know that small children do not have the attention span to listen and they need to be active and have different activities throughout the lesson. I first broke the class into 10 groups; I gave them paper and a crayon and asked them to draw what a person with HIV looked like. They all drew (well stick figures, but then described) a person with thinning hair, weak body, thin, skin problems, and sad. These are all correct symptoms of HIV in later stages and if a person’s CD4 count drops. I told them they were all correct, but what I wanted them to know was that HIV does not always look this way, a person with HIV can look like you and I. They can be healthy and happy. I told them there is now medicine that a person with HIV takes, this medicine helps them to be healthy, not pass the disease on to others, and live to be old grandpas and grandmas. Then we discussed why people with HIV are so sad. I told them about bullying and ostracizing behaviors and that it is wrong to treat a person with HIV this way. I also told them the ways you do not get HIV: holding hands, kissing, hugging, sharing a toilet, sleeping next to someone, sharing food and drinks, and just being close. I have learned that many people with HIV are ostracized by the community, I hate that children see these behaviors and copy them, what I hate worse is that the poor children with HIV have to suffer from the emotional abuse. I then had the children perform short dramas, one person was HIV positive and the second person was negative, the HIV negative person would not let the positive person be his friend anymore. Then I had a discussion with the children on how that made the HIV positive person feel, they all knew he felt sad and that it was wrong. The second play we added a third person, when this person heard the positive person being bullied they came over and put their arm around the positive person and said he would be her friend. I then ended the class with a small talk about bullying behaviors and asked the children to promise not to bully anyone.

I was impressed with the children and their knowledge, even at such a young age they knew that unprotected sex transmits HIV, blood transfusions can transmit HIV (which I later had to tell the older kids that most blood is screened and if they need a blood or organ transfusion they are probably very sick and could die without it. I said if it were me I would risk contracting HIV over dying.). But I also learned in standard 5 many of them did not know what sexual intercourse is. Because of the high rate of HIV transmission in the country the government has added what they call life skills into their curriculum. This teaches sex ed and about HIV/AIDS. But I do not think all teachers are teaching it thoroughly, which is understandable, talking to kids about sex can be very uncomfortable. At the standard 5 level I realized they were being very reserved and nobody had any questions. I used a tip I had heard before, I gave all of them a blank sheet of paper and they had to either write a question or “no question” on the paper. About 15 children in the class had the question what is sexual intercourse. I realized this is the hardest question for me to answer, well it was at first, now I have said it so many times I probably say it in my sleep. When I am asked this question I explain oral sex, vaginal sex, and anal sex. I believe many times children are only taught about vaginal sex, I want to make sure when they get the information from me they know all of the ways HIV and other STDs can be transmitted. The children did all know the right answers to the questions, what is HIV, what are ARVs, how HIV is prevented, how is HIV spread. So I know they are much more educated then they were in the past, I just do not think the teachers are taking the time to answer questions or thoroughly explain what they are saying. I think children are saying the answers like they would recite a times table or the alphabet, more from memory than from understanding; this scares me.

I spent two days total at the primary school. I had an amazing translator for those days; Jonas. He was very good at speaking to the kids and translated everything I said without a bit of hesitation or embarrassment, this is what I needed. After my second day at the primary school I went to do some home visits with the health volunteers. I did this one afternoon last week as well, I was in the village surrounding my house, I saw only elderly people that day. In the village around Malonda primary school (this village is about four miles up a hill from my house) I saw one 99 (!) year old woman, and two adolescents who are HIV positive. The 99 year old woman was very sweet, she could still walk around using a large stick as a cane, and her sister’s children assisted her. She was never able to have any children of her own, which I can imagine the controversy that stirred up back in her days. Even now when a woman cannot have a child they send the woman to have sex with other men to see if she can get pregnant. If she cannot her husband usually leaves her for someone who can have children. I told her many people suffer from infertility and it was not by any fault of her own, I also told her the reason she lived to be 99 so far is because she did not have any children to stress her out her whole life. Her only complaints were pain in her ankles and fingers, she told me it was from working hard in the garden her whole life (smart woman, most of them want to blame it on something else, or have no idea why their backs would hurt, carrying about 200 pounds or more per day on their head surely has nothing to do with it). I then went to visit a 13 year old girl who is HIV positive. Her mother had dies many years ago from AIDs. Her grandmother was her guardian now. I asked the girl if she knew how she got HIV, she was very shy but she eventually said no. I told her it came from her mother when she was a baby and that it was not her fault. Then we talked about her ARVs, her grandmother said the girl takes them herself without being asked now. I then asked her grandmother if she had talked to the girl about sex and what her future holds for her. The grandmother said no, she has not told her about sex, she is too embarrassed to talk to her. I asked the grandmother if I could tell the child was sex was, she very enthusiastically said yes! The child had apparently just been told do not have sex, well that does not work when a kid does not know what it is. I explained to her what sex was, she acted as a normal thirteen year old girl would, was very shy and seemed embarrassed. Her grandmother thanked me for talking to her and said that it would help her to be more open with her in the future and she would try to continue to have conversations with her. Then I saw a 14 year old boy and his mother whom are both HIV positive. The boy is very bright and very talkative; I could tell he has a lot of worries though. I talked to him about school and what people were saying at school. He says that some people know he is HIV positive and people in the community tell girls not to be his girlfriend because he is HIV positive. This made me very sad. I told the boy, he does not have to worry about having a girlfriend, he is more than able to have a girlfriend, and one day, many, many days away, when he is ready to have sex he can. We talked about how his ARVs reduce the transmission rate as long as they are keeping his CD4 count up and his viral load low. I told him even in the future if he wanted to marry a HIV negative woman it is very possible, they could even have children, with his wife having a huge possibility of remaining negative and their children being negative. He said that was all good, but he is not worried about having a girlfriend right now, they usually want sweeties and he does not have time for that, he has homework to do. His mother thanked me very much for coming to speak with them and giving both her and her son hope for the future, she gave me a load of peanuts from her garden as a thank you gift. I saw the boy the next day as I was riding my bike; she smiled very brightly and said, “Hello madam! How are you?!” It was good to see him out with the other kids.

The third day of teaching was with the secondary school kids (high schoolers), I knew I would have my work cut out for me this day but I thought surely I could get them all taught in eight hours right? I started their class with breaking up into ten groups and having a quiz on HIV. They also knew many facts and I felt understood the teaching very well. I ended my quiz with how many people are living in America with HIV a bit over 1 million and how many people do they think are living in Central/Southern Africa with HIV the answer is almost 28 million (I got these facts from the Tropical Handbook of Medicine, they are from the year 2006, I mainly wanted to give them a comparison). I explained to them that numbers of HIV infected people are three times higher than even the second highest place in the world. I then asked the question why? I always first got poverty; they explained that girls are sex workers to make money. I said this is not a good excuse; they have free medical care and condoms available. So I do not think that is the problem. Then I got premarital sex. Nope, not good enough excuse. I said everywhere in the world premarital sex is huge (I had also explained that having only one partner does not exclude you from having contracting HIV, I said HIV does not only happen to people who have sex with many people, the one person you have sex with can be HIV positive.). Finally I got the answer lack of education, I said yes maybe, but you are all being taught in schools now and you know how HIV is transmitted and prevented. Another child said lack of guidance and counseling, yes! I asked who should be talking to you that are not talking to you. Before my translator could even translate a child said, our parents. In many cultures in Africa it is a shameful thing to talk to your children about sex, I believe the only education these kids get is either in schools or through learning negative cultural practices. None of the classes got the second part that I wanted to discuss and that was the stigma and attitude towards HIV in their communities. I said the attitude of it being a shameful and terrible disease is what is keeping people from knowing their status, therefor they are not on ARVs when needed, this is why viral loads are high and transmission happens. I then let all of the children ask any sex, relationship, and HIV question they wanted on the piece of paper. I got so many questions! Some examples are:

Why does sex feel good?

Why is sex good?

Why do people want to have sex?

My parents said if I wait 7 days after my period I can have sex without a condom and not get pregnant is this true?

Does a man have to be on top during sex?

Why does sex hurt the first time for most girls?

Why do all of the girls in standard 2 want to have sex with older men? I made the class answer this one, they said penis size, experience, and sometimes their parents make them do it for money.

Does it feel different when having sex with a circumcised vs and uncircumcised man?

What age is it ok to have sex?

Why does everyone say that youth cannot be in relationships?

Why do people say HIV is in my future? (This one made me very sad.)

Do people with HIV have sexual feelings?

If you say we can have a relationship without sex and we can kiss and hug, what should we do when we get sexual feelings?

Should I tell people I have HIV?

How do I get my parents to talk to me about sex?

Should we practice sex with our friends to get better?

Then, Madame I want you to be my girlfriend. And another one, without you there is nothing. Oh teenagers!

I answered all questions the best I could without a bias or with my morals. I also made sure to explain that sex is not a bad or dirty thing. I hate that is so often what we teach children. I always say in the right circumstances sex can be great. You just have to make sure you are ready for it. Each session with these classes took about 2.5 hours. I was exhausted after each one. I would ask the kids if they were sick of talking about sex, they would all scream no! I think they really loved it, I have never seen groups of 100 plus teenagers so engaged. With all of the groups many of them had to miss breaks, be over an hour and a half late to lunch, and then stay after school; none of them seemed to mind one bit. I am hoping these talks did some good and that more kids will get tested and if they choose to have sex do so safely. I am still planning on having a talk with the girls, I have thought about coming up with a survey to hand out which they do not have to include their name. I want to know what activities these girls are engaging in and then I can do further lessons based on the information.

So those were the ups of the week, the downs were not major; I can just feel myself become much quicker to be annoyed. I think after seven and a half months in Malawi I am sometimes tired of dealing with the same shit every day. I was supposed to be at the school by 7:30 on Monday morning. Like I said it is about 4 miles straight up a hill. Mary had said I could borrow a bike from her, she was at my house at 6:15 to confirm, I said I would come over at 6:45 to get the bike. I went at 6:45 and she said her husband took it and I would have to wait thirty minutes, this is fine, but she should have told me they needed it and I could have walked to the school. So I waited an hour and she finally came over to say the bike was back. She then told me that a woman had a one month old baby and her milk had not come in so she was never able to breastfeed. Apparently the hospital told her to feed the baby water and her milk would come in, well this pissed me off. Mary wanted to go get some formula we had in the library and give it to her, I said yes, do that. She then thought I was going to go with her, this would have taken at least an hour. It made me more annoyed, she knew I had to be at the school by 7:30 it was already 7:45 and I had to cycle there. The concept of being on time does not exist in this country and I am getting a bit tired of it. Then I got to get on the bike, the seat is pretty high for me, and there are no pedals, so it is hurting my feet to pedal against the bars. My skirt then begins to get wrapped up in the chain. I was pissed at this point, I did not throw the bike because it does not belong to me, but I did scream “cock sucker” at it as least once as people were passing by. Thank goodness nobody speaks English and also not terrible things like that, I also do not know why cock sucker is so bad or what I resort to when I am mad, but it is usually what I call inanimate objects when I hate them. My wheeling duffel bag has been a cock sucker many times. Finally I had to walk a bit up the hill and it cooled me down a bit, well not really cooled me down, I was drenched in sweat. But I then came up with the idea of tying my skirt in a knot and it was much easier. I was done being angry that day. But then that night I felt sad for some reason. I think it is just hard to live alone all of the time. I did it a lot in KC but I also had my dogs and the option to go see friends when I wanted. Also working with people and being social there was a great help as well. It is not that I cannot be social here; when I am social it is mainly with children who do not speak English or with adults with whom there is a huge cultural gap. It just makes it hard some days. But I also know that I am much happier doing the work here than I would be at home right now and most days I am very comfortable and content.

Then on Wednesday a man came to the school to say that my solar panel was broken. At first I thought he was talking about how Mary wanted to switch out my battery or something, it had been having problems. Strangely on Tuesday night it worked great, I even thought to myself, this is like when old people walk for the first time in 10 years the day before they die. I knew it was not a good sign, but I chose to ignore it and get every last bit of power out of it that I could. I then thought he meant somebody broke into my house and tried to steal the battery. I was not convinced that this would actually happen. I literally leave things in the yard all day, I have people in and out of my house and nobody has ever looked twice at my things. Mr. Mhango said this is a major problem we should go investigate. I said, even if somebody stole all of my things, what am I going to do? How is it going to be any different than if I go home and see the problem now or if I finish teaching for the day? So I finished teaching and came home and asked Mary what happened. She said the battery exploded. I went home to find my stuff everywhere and battery acid all over the floor. I was thankful that I was not home, especially not in the room, I am sure I would have been injured. People days later are still asking me about the explosion at my house, it was heard all over the village. Ester (the woman that brings me water) helped clean up while I went with the girls to get my water (yes 9 year old girls can carry more on their head than I can). There is a film of battery acid all over my floor still. My dad and uncle told me to use baking soda to try to get it off; I have bought some today, so I know what I will be doing most of my day tomorrow. So I am not able to charge my phone or computer right now at home. I one day charged it at Mary’s and another day took it to the stand about a mile away from my house to have it charged, it costs about 10 cents. Not being able to use my phone nearly as much and not have my computer is making me feel even more isolated. Thank goodness for books, I have been going through them at an alarming rate; they are keeping me very entertained. I am on my fifth book in about three weeks; this one is 555 pages so it is going to take me about four days instead of the standard two right now. I have spoken to the founder about my issue with the battery and that I cannot afford 250 dollars to buy a new one, I believe they are going to provide one for me! It will be nice to have a decent battery for once.

Thursday morning I went to nearest clinic to get condoms to hand out at the dance we were having on Friday. I have been told the health personal that work in the village will not give condoms to teens; they feel it encourages them to have sex. Of course this makes me angry, no teen says, well now that I got this condom I am going to go out right now and have sex. Even if it does for a few, it more importantly is protecting those whom are having sex without condoms because they do not have easy access to any. So I walked the 6.5 miles (well I ran there with my backpack and walked home because of the heat and the eggs in my bag) to get condoms for distribution. Then that afternoon I was supposed to have a meeting with the girls, Mary said I could have the bike in the afternoon, once again it was not available on time. I wanted to tell Mr. Mhango that there was no way I could walk and make it on time to meet with the girls before school was over, my phone was dead, I had no credit, and it was pouring down rain. I ended up doing a very Malawian thing; I just did not show up. I got my phone charged and got bored of sitting in my house so I went to Mary’s that evening, the children were playing, and older girls were working on pounding maize for flour and then separating the kernels from the parts that have been crushed. I got to learn how to do all of these things.

The next morning I took the morning off. I felt like I needed it. Then in the afternoon was the dance. Lots of kids showed up and they had a good time. I spent most of my time holding sleeping babies so their siblings could dance. Anytime I tried to dance everyone stopped and made a circle around and just stared. I am only ok with this when I have had about 7 double rum and diets; we unfortunately were not serving alcohol there. Then I decided to hand out condoms. What a nightmare, the little kids were trying to snatch them and I was being pushed and shoved. One kid tried to rip them out of my hands. I lost it. I hated being disrespected after going through all of that trouble to try to help them. I know the kids did not know what they were or why they could not get them, but they certainly can still have manners. I grabbed one kid by the arm and starting yelling. It did not make much of a difference. Then I had teenagers telling me that three was not enough. This also made me mad, I said if I can walk 6.5 miles to get condoms for you, you can certainly walk your ass there and get them yourself. All of that aside, I am glad some people will be having safe sex, at least three times. I do want to have a place in the villages where condoms can be handed out; I am going to look into it.

The icing on the cake was at 1:30 in the morning when I woke up because a three inch cockroach was crawling in my hair. It freaked me out and I did not go back to sleep for about an hour. Then of course my door was being pounded on at 5:20 this morning. I just wanted to sleep in one day, I ended up going back to sleep until seven thirty, I almost felt guilty for sleeping that late. I have now come into town and done my grocery shopping for the week. I am also taking advantage of charging everything! I am not sure what this week will bring. I think I will go to the primary school near my house for HIV education there; hopefully I will have the girls meeting, and conduct some surveys. I believe we are also going to visit with some government officials about the clinic this week; it is as slow of a process as I thought it would be.

Mr. Mhango also told me I am an expert on teaching HIV; he says I need to write a book on how to teach HIV/sex education in Africa. At first I thought he was crazy, but now I realize it is not that bad of an idea. Maybe once I get a solar panel I will work on putting together some sort of guide and teaching manual. I know something needs to change the way it is taught. I certainly cannot go to every school in this continent to do the education!

And if you do not want to read all of that. Here are some pictures to look at instead.